Pain on deep inspiration, when an inflamed gallbladder is palpated by pressing the fingers under the rib cage is known as:

Appeared in: DSSSB 14 August 2024

Explanation

Murphy's sign is the hallmark sign for acute cholecystitis (inflammation of the gallbladder).
It is elicited by asking the patient to inspire deeply while the examiner palpates the right subcostal area.
A positive sign is characterized by a sudden, sharp pain that causes an abrupt stop in inspiration (inspiratory arrest) as the inflamed gallbladder touches the examiner's hand.

Option A: Rovsing's sign is associated with appendicitis. It is positive when palpation of the left lower quadrant elicits pain in the right lower quadrant.
Option B: Psoas sign (or iliopsoas sign) is also a sign of appendicitis, specifically when the appendix is in a retrocecal position and irritates the psoas muscle.
Option C: McBurney's sign refers to deep tenderness at McBurney's point, located in the right lower quadrant, which is a classic indicator of acute appendicitis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Physical assessment signs for abdominal pathologies as background academic context rather than a clinical decision trigger.
Accurate identification of these signs is critical for the differential diagnosis of acute abdominal pain, helping to distinguish between urgent conditions like cholecystitis and appendicitis.
When performing the Murphy's sign maneuver, the nurse should apply firm but gentle pressure to avoid causing unnecessary pain or rupturing an extremely inflamed gallbladder.
A positive Murphy's sign is a significant finding that requires prompt reporting to the physician for further diagnostic workup (like an ultrasound) and intervention.

How to Approach the Question

First, analyze the keywords in the question stem: 'pain on deep inspiration', 'inflamed gallbladder', and 'palpated under the rib cage'.
Recognize that the gallbladder is located in the Right Upper Quadrant (RUQ) of the abdomen.
Evaluate the options provided. Recall or deduce the anatomical location associated with each sign.
Rovsing's, Psoas, and McBurney's signs are all classic indicators for appendicitis, which is typically located in the Right Lower Quadrant (RLQ).
Identify that Murphy's sign is the specific maneuver used to assess for gallbladder inflammation in the RUQ.
Conclude that the described finding is Murphy's sign.

Concept Tested & Keywords

Concept Tested: Physical assessment signs for abdominal pathologies
Stem keywords: pain on deep inspiration, inflamed gallbladder, palpated, under the rib cage
Lead-in keywords: known as
Clinical cues: Location of pain (under the rib cage) and organ (gallbladder) point to a Right Upper Quadrant (RUQ) pathology.

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E6 Medicine Harrison 22e Part 2 pp. 636-638, 499-501

E6 Anatomy Workbook BDChaurasia V2 10e p. 106-108

Practise the full DSSSB 14 August 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.